ABCD Exchange : August 1998 : President's Letter - Lethal Drug Abuse Prevention Act

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Letters to the Editor

Lethal Drug Abuse Prevention Act: The fate of HR4006/S2151
by Joanne Lynn, M.D.

As part of our ongoing effort to get federal officials to pay attention to end-of-life issues (How could they not?! Three quarters of us die in Medicare!), a group from ABCD met with the House Judiciary Committee staff director in early July. We had come to express our concern about the Lethal Drug Abuse Prevention Act of 1998 (described elsewhere in this issue). We wanted to assess whether the bill had any real likelihood of being taken up in the waning days of the congressional session. We were assured that there would be no hearings on it until the fall, and that it would not come up for a vote in this session. The staff director claimed that the bill was just "out there for comment."

Imagine our surprise when, the very next day, a hearing was scheduled for the following week! Everything that has happened on the bill since then has been too fast and too thoughtless. Maybe the bill's proponents feel it doesn’t stand a chance if the issues have clear discussion and consideration. In fact, this bill could be a calamity for all of us who want reliably good care for dying persons and their families. Making dying worse and making care less reliable will increase the demand for physician-assisted suicide

In a turnabout of the views of the bill's proponents, I now firmly believe that a vote against this bill is a vote against physician-assisted suicide. Proponents of the bill are well-intentioned, but they do not see that this legislation will likely reverse the recent trend toward better pain relief at the end of life. Making dying worse and making care less reliable will increase the demand for physician-assisted suicide. Those who want less demand for physician assisted suicide should be against this bill.

This bill envisions having the DEA investigate allegations of wrongdoing, which are to be judged by the ambiguous and unworkable standard of the "intent" of the physicians involved. Physicians will want to avoid the uncertainty, fear, exposure of patient privacy, and loss of reputation such proceedings entail. Many will find it more acceptable to provide less vigorous relief of pain and other symptoms rather than to risk these harms.

Our Senate testimony on July 31 included hypothetical cases to show how severe and pervasive harms will come simply from investigations of alleged wrongdoing - even if the alleged perpetrators are eventually completely exonerated. (Read the full testimony.) The "advisory board" that the bill would create comes at the end of the investigation, so it can’t diminish the problems created by making a police authority, the DEA, into the arbiter of the standards of good end-of-life care. Even the bill's standard of "intent," which is workable enough as a guideline for medical ethics, is completely impractical as a component of criminal law.

Readers will want to review the proposals and arguments for themselves, and we are happy to be of help. The ABCD website features links to the current version of the bill, our testimony, and other documentation. Whatever you feel about this bill, contact your Senators and Representative right away! We have made it easy for you by giving the e-mail links from our webpage, and the contact persons for the Senate Juciciary Committee, too.

The House is poised to vote on this when it returns and the Senate has it ready for "markup" in the Judiciary Committee. If you only make one e-mail or phone contact, have it be to your Senators, urging that the bill not be taken up at all in this session. Ask them to consider it as part of a more comprehensive approach to reducing the demand for physician-assisted suicide as an outcome of improving overall end of life care. Urge them to support a filibuster and resist having the bill attached to a "must do" appropriations bill.

Inadequate care of those nearing the end of life should be an outrage and a shame for a society which could readily do so much better. Americans are afraid of what awaits them in that last phase of life. But this bill only worsens the situation. There does need to be a federal agenda—and that requires addressing standards and financing, having thoughtful discussion, gathering data, and trying out innovations. ABCD is committed to that agenda. Only real reform will allow Americans to be confident of comfort and choice at the end of life.

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This content is provided by Americans for Better Care of the Dying. For more information, visit www.abcd-caring.org.